Sonesta Nursing Home Limited

We found the following examples of good practice.

The home had responded to peoples’ choices and individual needs during the pandemic to help them carry out activities outside of the home. Due to the nature of the residents at the home, residents only ventured outside of the home when escorted by family members. Masks and sanitiser was provided and residents carried out a lateral flow test (LFT) when they returned to the home.

The provider admitted people directly from hospital seven days a week in order to help with the shortage of beds in secondary care. People who had a negative PCR were admitted to the home and then isolated for the appropriate time as set out in the government guidance at the time. Following this a further PCR would be taken.

The provider was following the current government guidance regarding care home visiting. People had three named visitors as an essential care giver. Visitors entered the home by an entrance in the garden area adjacent to the back of the lounge. An area of the lounge had been put to one side and partitioned off to act as a testing area. Once the visitor received a negative test, they would be escorted to the residents room. Visitors left by the same entrance to minimise ant spread of infection. Information was available for visitors to follow. Visitors were also instructed on how to use personal protective equipment (PPE).

The provider had adapted the home entrances to accommodate PPE and testing stations for people living at the home and their visitors.

the home had sufficient supplies of PPE. There was two PPE stations available on each floor with donning and doffing areas. Staff had received training in infection prevention and control and how to don and doff PPE.

The provider had a system in place to ensure staff had the necessary vaccinations and had completed the necessary Covid 19 testing prior to working in the home.

The provider had completed a number of health and safety risk assessments including infection prevention and control and an in depth BAME risk assessment with each member of staff. These were regularly updated and check lists were in place to ensure essential tasks such as ensuring testing was complete.

The layout of the service and communal areas supported social distancing. The premises looked clean and hygienic throughout. There were cleaning schedules in place and adequate ventilation.

The staff were aware of who to contact should they have an outbreak of Covid 19 and the protocols to follow.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Sonesta Nursing Home Limited is a care home providing personal and nursing care for up to 32 people. At the time of the inspection there were 23 people living at the service.

People’s experience of using this service and what we found

People felt safe living at the home; relatives confirmed the care and support provided maintained people’s safety. Staff were able to tell us how they safeguarded people from potential abuse.

The registered manager and management team were well regarded by people at the service and relatives and we saw evidence of good quality care provided to people. We found some areas in which records needed improvement to reflect the care given and to show care had been reviewed. For example, quality assurance processes such as audits were in place to help ensure standards were upheld but had not found some minor issues we identified at the inspection. We saw complaints were dealt with promptly and actions were taken following accidents and incidents.

There were enough staff to meet people’s needs and to provide care in a caring and personalised way. There was a long-standing staff team and this meant staff understood people’s preferences and routines. Staff treated people with respect and dignity. People were fully involved in their care as much as they could be. People’s right to privacy and confidentiality was respected and integral to the ethos of the home.

People and their relatives told us the care and support provided met people’s needs. Staff received training necessary for their roles and felt fully supported by the management team. The registered manager and management team were available for the staff to call on at any time if they needed advice or guidance.

Risks to people’s safety and well-being were assessed and mitigated as much as possible. People’s medicines were managed safely and staff were competent to safely administer medicines.

The home was clean. Staff had received infection control training and protective clothing including gloves and aprons were available to them.

Most people enjoyed the food provided for them and it was suitable to meet the diverse range of people living at the service.

People accessed healthcare services as needed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Relatives and other visitors were welcomed into the home at any time. There were some activities at the service and in the summer people used the garden regularly.

The registered manager kept themselves up to date with changes in legislation and practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 21 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Sonesta Nursing Limited is registered to provide accommodation with nursing and personal care, diagnostic and screening procedures and treatment of disease, disorder or injury, for up to 32 people. The people living at the service are older people, many with dementia and physical health needs. There were 23 people living at the service at the time of the inspection.

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We saw kind and caring interactions between staff and people living at the service on the day of the inspection. People and visitors confirmed staff were caring and attentive to their needs.

The service was clean throughout. We noted not all food was labelled in the fridge but the registered manager addressed this on the day of the inspection.

Staff received appropriate support through supervision and training, and told us they enjoyed working at the service.

Care records were up to date and described people’s needs. Risk assessments were in place and gave detailed guidance on how to keep people safe.

The service accommodated and supported people well with complex physical health needs and health professionals spoke well of the nursing care provided to people living there.

Medicines were safely stored and administered.

We could see there were sufficient staff to meet people’s needs on the day of the inspection. People and their relatives confirmed this was routinely the case. The service did not use agency staff to cover absences. This meant there was continuity for people receiving care.

The service followed safe and robust recruitment processes to ensure that only suitable staff were recruited to work with vulnerable people.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. We found the service was working within the principles of the MCA. The procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). The service was compliant in relation to MCA and DoLS.

The registered manager and senior nursing staff carried out a range of audits to check the quality of the service. These covered areas such as care records, medicines management, cleanliness and staff supervision. Completed quality assurance questionnaires from people living at the service, their relatives and professionals working with the service gave positive feedback on the care offered to people at the service.

We undertook this unannounced focused inspection of 9 March 2016 to check that the provider had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to these matters. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Sonesta Nursing Ltd on our website at www.cqc.org.uk .

Sonesta Nursing Limited is registered to provide accommodation with nursing and personal care, diagnostic and screening procedures and treatment of disease, disorder or injury for up to 32 people. The people living at the service are older people, many with dementia and physical health needs. There were 24 people living at the service at the time of inspection.

During this inspection we met the registered manager who had run the home for over 16 years, and was also the owner. The conditions of registration for the service state that a registered manager is required. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection, there was good feedback about the caring nature of staff and we saw good interactions between staff and the people using the service. We saw people were treated with dignity and respect and this was confirmed by people living there.

We found risk assessments had been updated and were thorough so staff were aware of people’s needs and were given detailed guidance on how to keep them safe.

We saw the registered manager had begun to put in place more effective audits to monitor the quality of the service. She had been supported to do this by officers from the local authority and told us she was committed to undertaking these on a regular basis. We found evidence of the registered manager discussing the breaches identified at the inspection in November 2015 with staff, people living at the service and relatives, and action had been taken to improve the quality of the service.

As a result of the above, we found that the provider was no longer in breach of the regulations identified at the inspection on 5 November 2015.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Risk assessments had been carried out for each person and plans were put in place to minimise risks.

People who used the service were protected from the risk of abuse. Staff had received training in preventing abuse. They could describe what might constitute abuse, the strategies in place for preventing abuse, and what steps they could take to escalate concerns.

People who used the service were only deprived of their liberty when this had been authorised by the Court of Protection, or by a Supervisory Body under the Deprivation of Liberty Safeguards (DoLS). No one at the service had applications submitted under these systems. However, the provider had a written DoLS policy and had supplied staff with training in the operation of the DoLS.

Appropriate checks were undertaken before new staff began work. For example, the service carried out Disclosure and Barring Service (DBS) checks and followed up on people's references. Checks of nurse's registration status with the Nursing and Midwifery Council were also carried out.

Is the service effective?

Various audits were carried out to ensure the service was providing care effectively and in a suitable environment. For example, the nurse manager carried out a check of the medicines administration procedures every three months.

Staff described strategies for obtaining verbal consent before they provided care. The care records showed people were asked to give their written consent appropriately. The provider acted in accordance with legal requirements where people did not have the capacity to consent.

Is the service caring?

We spoke with four people who were using the service. They were satisfied with the care. One person said, "It is quite good here. I get on well with the staff." Another person told us, "I can't fault the care. If there is something wrong then they leap into action."

We spoke with a relative of someone who was using the service. They were pleased with the care provided by the service. They told us, "I live close by and visit my [relative] at different times of the day. The staff are always good and responsive. It is a nice, friendly environment. I think it is fantastic."

Is the service responsive?

The people we spoke with told us staff responded promptly if they asked for help. We also examined how the service responded to complaints and what actions they took in response to accidents involving people who used the service. The service responded to concerns promptly and carried out investigations in relation to any accidents. Actions were taken to prevent accidents from happening again.

Is the service well led?

The provider had effective systems to regularly assess and monitor the quality of service that people received. This included obtaining feedback from people using the service, their relatives, and members of staff.

The provider had written policies, including those relating to safeguarding, whistleblowing and the operation of the Deprivation of Liberty Safeguards. The provider involved staff in an induction process which included a review of these documents. Staff were also asked to complete mandatory training courses to keep their skills up to date.

People were protected from the risk of infection because effective systems were in place to reduce the risk and spread of infection. Cleaning schedules were in place and up to date. Communal bathrooms were generally clean and one had been completely refurbished along with the staff toilet. Some toilets had been replaced. Further refurbishments were due to start the following week.

People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. The home was warm on the day of the inspection and the heating system had been serviced. A person we spoke with said 'yes, I'm warm enough.' Systems were in place to record maintenance needed and undertaken and equipment was checked regularly.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. The home carried out a series of regular audits and took account of complaints and comments to improve the service. This meant that risks were proactively managed, quality of care delivered was assessed and feedback was acted on.

Care plans were comprehensive and up to date. Entries showed that staff involved people. Risk assessments were in place. Care and treatment was planned to ensure people's safety and welfare.

One person said 'food is good'. Another wanted more variety. Surveys confirmed this remained an issue after menu changes following our last inspection. The amount of food was sufficient and support provided to help people to eat. However, the home was not providing enough variety in the food offered.

The five communal bathrooms and a staff toilet were not clean. Three toilets did not flush adequately. Tiles in the bathrooms were chipped and broken. Two people's rooms were cool, as was the lounge. The service delivered by the home was not following a number of its own policies.

People said staff were 'very pleasant' but more than one said that 'sometimes it feels like I wait a long time for someone to come.' Most people living in the home needed a hoist. Staff may not always be available when needed as only three staff were on duty at night.